基于“久病入络”理论的益气养阴活血通络法治疗糖尿病周围神经病变的临床研究

Clinical Study on Treatment of Diabetic Peripheral Neuropathy with Yiqi Yangyin Huoxue Tongluo Therapy Based on the Theory of“Long Disease Entering Collaterals”

目的:观察"久病入络"理论指导下的益气养阴活血通络法治疗糖尿病周围神经病变(DPN)的临床效果。方法:选取2019年10月-2020年10月本院收治的DPN患者126例为研究对象。依照随机数字表法将患者分为中药组和对照组,各63例。对照组给予西医基础治疗,中药组在对照组基础上给予益气养阴、活血通络中药,两组疗程均为8周。比较两组治疗前后中医症状评分、血糖指标、神经电生理指标、血液流变学指标,观察两组临床疗效。结果:治疗后,两组中医症状评分均较治疗前明显下降,差异均有统计学意义(P<0.05)。治疗后,中药组肢体麻木、肢体刺痛评分及总评分均低于对照组,差异均有统计学意义(P<0.05);治疗后,两组神疲气短、倦怠懒言评分比较,差异均无统计学意义(P>0.05)。治疗后,两组FPG、2 h PG、HbA1c、全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原均较治疗前明显下降,且中药组上述指标均显著低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组腓总神经和正中神经的SNCV、MNCV均较治疗前明显上升,且中药组上述指标均显著高于对照组,差异均有统计学意义(P<0.05)。中药组总有效率为92.06%,明显高于对照组的68.25%,差异有统计学意义(P<0.05)。结论:"久病入络"理论指导下的益气养阴活血通络法治疗DPN,可以改善患者肢体麻木、肢体刺痛等临床症状,降低血糖,增加腓总神经和正中神经的传导速度,降低全血高切黏度、全血低切黏度、血浆黏度及纤维蛋白原,具有较好的临床效果。

Objective:To observe the clinical effect of treating diabetic peripheral neuropathy(DPN)by Yiqi Yangyin Huoxue Tongluo therapy under the guidance of"long diseases entering collaterals"theory.Method:A total of 126 DPN patients admitted to our hospital from October 2019 to October 2020 were selected as the study subjects.According to the random number table method,the patients were divided into traditional Chinese medicine group and control group,63 cases in each group.The control group was treated with basic Western medicine,the traditional Chinese medicine group was treated with traditional Chinese medicine for Yiqi Yangyin Huoxue Tongluo on the basis of the control group,the course of treatment of both groups was 8 weeks.TCM symptom score,blood glucose index,neuroelectrophysiological index and hemorheology index were compared between the two groups before and after treatment,the clinical efficacy of the two groups was observed.Result:After treatment,the scores of TCM symptoms in both groups were significantly lower than those before treatment,the differences were statistically significant(P<0.05).After treatment,limb numbness,limb tingling scores and total score in traditional Chinese medicine group were lower than those in control group,the differences were statistically significant(P<0.05).After treatment,comparison of the scores of mental fatigue,shortness of breath,burnout and lazy speech between the two groups,there were no significant differences(P>0.05).After treatment,FPG,2 h PG,HbA1c,whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity and fibrinogen in the two groups were significantly lower than those before treatment,the above indexes in the traditional Chinese medicine group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).After treatment,the SNCV and MNCV of common peroneal nerve and median nerve in the two groups were significantly higher than those before treatment,the above indexes in the traditional Chinese medicine group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The total effective rate of traditional Chinese medicine group was 92.06%,which was significantly higher than 68.25% of control group,the difference was statistically significant(P<0.05).Conclusion:The treatment of DPN by Yiqi Yangyin Huoxue Tongluo therapy under the guidance of the theory of"long illness entering collaterals"can improve the clinical symptoms such as limb numbness and limb tingling,reduce blood glucose,increase the conduction velocity of common peroneal nerve and median nerve,and reduce the whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity and fibrinogen.